Provider Demographics
NPI:1710132170
Name:WESTOVER, BRIAN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WESTOVER
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WILCOX AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1206
Mailing Address - Country:US
Mailing Address - Phone:845-691-8501
Mailing Address - Fax:
Practice Address - Street 1:8 WILCOX AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1206
Practice Address - Country:US
Practice Address - Phone:845-691-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017177-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist